SPFPP 252: OHA Series - Introduction and Overview

Beginning this project, I had a hypothesis that people who tested positive for an STI would not find the resources they obtained from health care providers useful if they’ve been given any resources at all. Only one response was yes to the information being useful, but with the caveat that it was very basic. Another consistency with the SPFPP 2021 herpes survey results was that people who test positive for an STI are more likely to not test positive for a second one. My reasoning behind that is because of the communication skills they develop through their own self-education about STIs leads them to vetting partners differently than they have in the past about sexual health. 

What you’ll find over these podcast episodes is that the most useful resources in navigating sex after their diagnosis is that they didn’t come from their health care provider at all. Whether trich, herpes, chlamydia, or HPV, the resources they received from their health care provider wasn’t useful for them. In these podcasts you’ll hear many of the guests share that their journeys led them to online resources and social media accounts talking about this very thing. This begs the question “What is it that these people who’ve tested positive for an STI are learning that makes 70% of them go on NOT to test positive for a second STI?”. How do we integrate their lessons into the existing CDC recommended STD Prevention efforts? 

I further hypothesize that while use of condoms is presented as the “best” protection against STDs, it is worth noting that my guests speak about using condoms with partners, yet still tested positive. A major difference is that they learned to communicate in their relationships about their needs and set expectations with partners intentionally rather than under assumptions. This means that they were initiating conversations about sexual health, PROPER barrier use, and STI testing routines. The CDC says to get tested and know your status, but it also says to remain abstinent and practice mutual monogamy. Many of the prevention efforts as they exist are assumed norms in sex around intercourse. Part of the communication people have expressed learning is that there needs to be an uncoupling of intercourse and sex, and then separate sex from pleasure.

That last part I predict can be done in sex education. Our podcast guests from this series speak to how kink and BDSM negotiations for play between partners has nothing to do with sex most of the time. What happens in these negotiations is that language is being co-created for consent, people are identifying and asking for their needs to be met while determining if their play partner is capable of meeting their needs for the play being negotiated. Boundaries are set during these negotiations, and an established STOP or safe word is determined. During this vetting process, we identify potential red flags for abuse or green flags for a healthy interaction. Through the practice of these negotiations, people are able to move forward and have set expectations for an interaction and know that if anything goes wrong or is off, that’s been pre-negotiated and they know where to go for support. Equipping people with this communication foundation could not only minimize STIs, but also rape, violence/harm, negative mental health impacts, abuse, and self-suffering in silence due to not knowing where to go for support.

This podcast series has brought to the surface these needs here in Oregon which reflect much of the podcast’s experiences that have been shared on SPFPP since 2017. Thank you to the team at the Oregon Health Authority for allowing me to explore these findings with the funding to put time into it and get these findings to back up the work being done through SPFPP. This sets us up to explore the need for integrating these experiences into prevention efforts.

Episode 252 Transcript

The Oregon Health Authority Partnership and STI Minimization

00:00:00 Courtney Brame: Hello everyone. Welcome to Something Positive for Positive People. The next series of episodes that you are going to hear actually including this one. Um there will be 12. Yeah, it'll be 12 whole episodes from the Oregon Health Authority. So um, I hadn't made an official announcement or anything like that. But the Oregon Health Authority gave us $10,000 to essentially run our podcast away. We have been with a little more attention to detail including some survey information and um things that if you've listened to Something Positive for Positive People over the last 5 and a half years now then you already know what we're about. You kind of have an idea about some of the things that we talk about uh sex with sex education, sexual health is mental health, sex positivity as a means of creating an anti-stigmatizing atmosphere in the health care setting. uh and then some. Right. So what these podcast episodes did well- what I did was I collected survey information and interviewed 12 people. Unfortunately uh one person was not okay with us sharing the interview which was perfectly fine.

00:01:39 Courtney Brame: Um she did take the survey for me and um we have that data here as well. Um so the rest of it uh you hear in-depth interviews from people where consistently what we find is that there is a direct connection between someone testing positive for an STI and then how they um how their communication begins to evolve over time. Right? So from the 11 interviews that we have um you'll hear from people who are um sex positive uh majority of the people have had an experience with herpes. Most people speak to uh herpes and something else uh in the past but there's one person who just had genital warts. Uh but what we have here is communication, communication, communication, communication. And what this particular series of podcast episodes highlights is a need for there to be an integration of how people learn to navigate STI stigma after an STI diagnosis and the sex education that we receive. Um, for example, there were people who spoke about how they didn't really talk about sex or sexual health until after their diagnosis and then they began to initiate the conversations.

00:03:09 Courtney Brame: So, with this in practice, what happens is we begin to get better at it. Now, if people are not having the conversation about their sexual health with partners, then what you see is that they're practicing not doing that and they get worse and worse at having the conversation. So, um I'm going to read a little bit from the narrative report that I wrote out uh so that you know there's an understanding here and then I'll just speak to what the experience was overall. But my hypothesis at the beginning here was that people don't get useful information from their healthcare providers. Uh what they do is if given any resources at all they go out and they look for the information on their own. So the self-education that they come across tends to be what the more useful information is. Another consistency here um and you'll find this in the 2021 Something Positive for Positive People herpes survey is that the people who test positive for their first STI are actually less common to test or I'm sorry are less likely to test positive for a second STI given the communication skills that they develop through their own education having to vet partners differently than they have in in the past about their sexual health.

00:04:36 Courtney Brame: And most people are navigating this in an ethical way to where we don't want to give someone an STI. We don't want to give someone herpes. Um, but the best thing that we can do is inform them of what the odds are that they might potentially get it. And if we do have it, give them the choice, right? And that's what we see here is that people learn to give that choice to their potential partners. Another hypothesis here was that while the use of condoms is presented as the best, and I use air quotes when I say that, protection against STDs, it is worth notice that my guests speak about using condoms with partners and still tested positive. And another thing here is that they not only learned to communicate about sexual health, but also their needs, their expectations. And they did this with intentionality rather than assumptions. So the initiation of these conversations about sexual health, proper barrier use with an emphasis on proper and STI testing routines is what uh supported them through navigating stigma after that.

The Flaws of Condom-Only Prevention

00:05:50 Courtney Brame: So while the CDC says that you know getting tested, knowing your status and remaining abstinence, practicing mutual monogamy, blah blah blah, many of the prevention efforts that exist as they are are just assumed norms in sex around intercourse. So what I mean by that is we don't assume communication. We assume condom use because what's constantly being pushed is that condoms are the best way to prevent STI. Second to abstinence, right? No sex, no STI. You can't transmit sex uh sexually transmitted infections if you are not having sexual contact, right? But what this does is put us in the position where we live in a sex avoidant society. And what I mean by that is we're not able to speak about sex even though we're doing it. And so while everyone is universally on board with wearing a condom, first off, what does that mean to two people where there's not a penis involved or if there's more people and there isn't a penis involved? And even the language on the CDC website uh use the male latex condom um every time you have sex.

00:07:05 Courtney Brame: All right. So now we have to get into defining what sex is. Are we talking about sexual intercourse or are we talking about uh only sex with a person with a penis? And we just completely omit the uh female condom or the internal condom. Um there's no discussion about barriers on sex toys. And I don't want to make this about, you know, how the CDC is speaking about safer sex practices, but what we're seeing here is that there is opportunity here to become more inclusive based on the information that we're getting from people about how condoms aren't 100% effective. You know, people still have sex and assume that they won't get an STI as long as a condom is being used for the person with the penis, right? assuming that sex is being had with a person with the penis and another person. But we don't emphasize that communication piece because barrier use properly and communication gives us a synergistic um level of it creates a synergy between the communication and the condom use.

00:08:22 Courtney Brame: And here's what that means. All right. Yeah, we're going to wear a condom. There's an assumption that no one's going to get an STI. There's a sense of relief that comes with knowing that a condom's used. However, condoms slip off. Condoms break. Condoms are used incorrectly. Someone could improperly remove the condom. Condoms get lost. We can speak to a number of things that happen with condoms. And so it's really important to not just assume the status of a partner, not just to assume if a condom slips off, oh, let me just put it back on and keep going. Like these are the kinds of things that we would think don't need to be said because they seem so common sense, common practice to people who might listen to this podcast, but the general public out there. And I mean even with youth, youth, they are becoming sexually active one way or another.

Sexless Sex Education and the STARS Model

00:09:26 Courtney Brame: Um, I've spoken to younger people who have tested positive for herpes, the first time that they've had sex, and we're talking about young adults. And so, equipping them also, um, this is another piece of what's come up throughout this podcast series is this concept of sexless sex education. So, one of the questions on the surveys that you'll see, it asks if people are involved in the kink and BDSM community. And throughout the podcast episode interviews that I've done, I've asked how the communication that takes place there is influential in uh or how I'm sorry the bits of communication that happen there for the nonsexual components like what use has that been to them or if they found that to be more useful for them in navigating conversations about sex even if sex is not always the topic of discussion. because you're talking about things that you do and don't like. So, things that may uh be boundaries, things that may be traumatizing or triggering. We're talking about our intentions around relationships.

00:10:36 Courtney Brame: And this goes right into Dr. Evelin Dacker's STARS model, which is talking about STI testing, turnons, avoids, relationship intention, and then what you need for safety. So this model works very well in the kink and BDSM community because of the negotiations that have to take place. And the aspects of the negotiations include seeking support if you're done wrong, identifying healthy or unethical or unhealthy behaviors and being able to respond to that accordingly. Setting and honoring boundaries, being able to get and obtain consent and honor consent. Being able to identify your needs and then ask for them to be met. As well as being able to not only say no, but know that your no is going to be accepted, received, and respected while also being able to hear no. None of that had to do with sex, but this kind of com communication is very common practice in the kink and BDSM communities. So these healthy interactions that are intentional and communicative um if we are able to equip youth in sex education classes with those tools then negotiations at recess can look very similar like hey you know here are the rules of the game um if I tag you you're it and then everyone runs away from you.

00:12:07 Courtney Brame: Okay. Well, if someone doesn't want to be touched on their hair, on their head, or slapped in the face or kicked, then these are things to be negotiated. And then if these things happen, uh they'll be able to speak to, all right, well, you know, if this happens, I'm done playing. I want to play something else. Or people can know, okay, we know not to touch you in the face. Actually, that's a good idea. Let's not hit anyone in the face, right? Because that's just a good idea. So, I find these sexless sex education uh components that happen in kink and BDSM to be really useful to uh people outside of a sexual context. Another thing that came up over the course of these podcast episodes is that there is a very very strong interconnection between pleasure and sex and intercourse. I believe that uncoupling these three things will allow for us to again just sexual health is mental health. We'll be able to see a person for more than what they're coming into a clinic or health care setting for in terms of testing, treatment, uh being seen by their healthcare provider for whatever it is because there is bias and judgment that comes with that.

00:13:30 Courtney Brame: And I'm finding over the years that the stigma is not about shame. It's not about um it's not really about, you know, how people feel about the STI itself. It's about people's discomfort with talking about sex. The more we can talk about sex, the more we can begin to understand how normal it is for someone to contract an STI. Now, it is perfectly fine for you not to want an STI. It is perfectly fine for you not to want to have sex with someone who knows that they have an STI. However, what's not okay is assuming and shaming people for their sexual practices, having an assumption of what got them to that point or what got us to this point because I'm part of this audience myself. So, this series is not just about people with STI’s. This is about uh the health care setting and what we can do in order to support our health care workers in being able to provide a sex positive anti-stigmatizing identity affirming validating space for people to be able to uh come in and have whatever their mental health response is as well to their STI diagnosis um so that they can receive the best quality quality of treatment and also go out into the world with an understanding of how to navigate this, how to talk to partners about this, how to seek support from family, friends about their STI status because we're not given these tools and

00:15:11 Courtney Brame: we don't want people to be preparing for contracting an STI because, you know, then it's an assumption that they'll get it. But the world that we live in today where your next sexual partner is literally a thumb swipe away from you from whatever part of the country, we have more access to sexual partners than we ever had before. And we are not equipped for this. We're not equipped for a lot of the stuff that we deal with. To be completely honest, we are not equipped to have, you know, every person that you might be attracted to within your radius who's also on the internet or dating site to be able to see that and have such quick and easy access to them. So, an accommodation for the rising SCI rates is for us to do our best to equip ourselves with the tools to cut through the potential uh harm that can be done from the readily accessible and available uh prospects that we have for sexual partners. And that just really from these podcast interviews and from these surveys, it looks like communication.

Transforming the Healthcare Touchpoint

00:16:21 Courtney Brame: The sex positive community is a space where uh many people have expressed being able to also practice these negotiations, practice saying uh what it is that they need and hearing no and being able to say no and receiving no. And there is a way for us to really integrate this kind of stuff together into a package deal for us to be able to get to the general public. And I believe that the best pathway to that is going to be in partnering with our health care providers as well as the people who are being sought after by folks who test positive for an SEI uh generally herpes because there's so many people online who are open about their status with tens and hundreds of thousands of followers where people are looking to them for this information and they're looking to them to answer more than they are able to chew off. So, what I foresee is a long-term partnership with the uh I mean here even with the Oregon Health Authority and partnering with local sex educators and social media influencers where people might go to them for sex education because they just might not feel comfortable talking with their health care providers about this.

00:17:40 Courtney Brame: So if we're able to equip influencers with the general recommendation like they have graphics they're relatable. It's someone who is equipped with the knowhow and the bandwidth of course uh and the professionalism to be able to be sought after because people are doing it anyway. People have been reaching out to me far before I was even in a mature or wise place enough to be able to provide support to them in the way that they might have been seeking support. So when I think about the future of STD prevention, I think that it has to first evolve to become more inclusive. And that inclusivity uh means not assuming that sex with a condom is the safest way for us to be sexually active. It doesn't because that also invalidates the sexual experience of perhaps lesbian women or bisexual women or people who are trans who are left out of this equation completely. Um, and while our sexual protections and safety measures are all centered around body parts, let me just say that we can talk about putting barriers on different body parts because different acts can um bring about different types of STI.

00:19:23 Courtney Brame: So, if we're going to minimize and reduce the risk of potential sexually transmitted infections, it's going to start with first understanding that prevention is not what it is -not what it do. When we say prevention, we think to prevent it from happening. When we say minimization, we mean to minimize the risk of possibilities, indicating that there is still a possibility of something happening. And so if we're able to have this understanding going into our sexual experiences and know that hey you know this might happen all right if it's chlamydia gorrhea syphilis like let's go and make sure we get this treated follow the treatment regimen be comfortable with asking questions to our health care provider understanding some general frequently asked questions about like uh things like not sharing and splitting your medication with a partner. um things like that like the the a lot of the stuff that we would think or assume are common sense it's not it may not be so um one more component of this their status or not uh being able to disclose and I I think that sexual health providers healthcare providers are the initial touch point of STD prevention, STI minimization.

00:21:03 Courtney Brame: If we're moving forward with the concept that I have been speaking to on this podcast, not only does how you interact as a health care provider with a patient who is positive for an STI influence SCI status to a potential partner, but it also can influence whether or not they choose to do so. So, with that being said, if someone comes in and they get tested, they're expressing symptoms, you go through the test, you're like, "All right, you have uh herpes. Bye." Um, it's not a big deal. Don't, you know, you don't have to tell anyone, just wear a condom. Like, again, it goes back to that whole sex avoidant society that we live in. If health care providers are avoiding the conversation and patients are avoiding the conversation or just don't know how to ask questions or what to ask or how to feel or maybe dealing with not feeling like this is an appropriate place to speak about their sexual lives, we got to build that comfort. And one of the things that I foresee for Something Positive for Positive People as well is providing practice for health care providers to take a sexual history to get comfortable with talking to people and getting them to open up about their sex lives.

00:22:26 Courtney Brame: Not in an erotic way that is potentially you know… what’s that word? counter transference or something where a therapist and a patient like have their professional dynamic but the patient begins to get attracted to the therapist or something and yeah like whatever that is like we're not advocating for that kind of thing. All we're advocating for is a level of comfort because when people come into the doctor for whatever reason there's always some unease about what could potentially be going on. I'm sure people have Googled before going to the doctor to see what it could be and oftentimes they're just looking for some kind of assurance that it's not whatever that thing is that they saw when they did their search and that's not always, you know, that it's not always going to be a no. So people are mentally preparing themselves oftentimes for the worst and they come in with this anxiety. And this anxiety on top of being met with a health care provider who is not really well practiced in talking about what's being talked about which is sex, sexual health.

00:23:40 Courtney Brame: This makes for a recipe for stigmatization. And as we know, sometimes people who have been diagnosed with herpes go home and they feel like their life is over. Their love life's over. And the whole reason that this podcast started was because people wanted to kill themselves because they had a herpes diagnosis. They were diagnosed with herpes and they had their own internal feelings and shame about their diagnosis. and excuse me. And that led to or that often leads to a lot more mental health impacts negatively that influence the potential risk of transmission. So I am personally excited because this opens the door for more opportunity to explore this even further. And I'm going be honest, like my survey that I took, like this was it was me having a hypothesis and asking the questions that I thought would be most useful to um explaining uh what what's coming next, like what's to come because what I see is or what I see as next to come is that we're going to be giving these healthcare providers practice.

00:25:01 Courtney Brame: We're going to be teaching sexless sex education whenever I go to these conferences and seminars. We're going to advocate for this idea of STI minimization. We're going to see about partnering uh sexual health education advocates with local organizations that provide STI testing and treatment so that people can have an understanding that hey, you can come to these places, frequent them, get uh information, get condoms, get testing done because there's so many places out there that offer free testing and give away free condoms and lubricant and as well as information packets and offer consultations even. But people just don't know that they exist. And it's important to me that we uplift these spaces and that we put them out there because this is going to be the fastest way of creating an anti-stigmatizing, sex positive and identity validating um sexual health care setting. So the doctors are going to become more comfortable, the patients are going to be more comfortable, and patients are going to have more confidence in speaking to their partners about their sexual health status and being able to even maybe bring them in for testing.

00:26:15 Courtney Brame: Right? So there is so much excitement that I have here and I am very much appreciative of the Oregon Health Authority for allowing me to explore these findings with the podcast. And I know I know these things. I talk about it all the time, but for me to have been able to really take my time and pay attention to the details here and people who um are in the state of Oregon to see what the potential trends are. All of these things really played such a big role in just like my confidence as someone who's in this work who doesn't necessarily have um any particular credentials outside of the five and a half years of experience that I had in this space with talking to people who are living with herpes with um conducting these surveys as best I can and utilizing the resources that I have available to me in order to make the most out of the stories that are being shared with me because they are so valuable and there's so much underneath the herpes.

00:27:21 Courtney Brame: So, um while I say that yes, the majority of people I've interviewed here uh all tested positive for herpes, but there's other experiences that very much parallel that kind of diagnosis. If we look at an STI and COVID, right? You know, we say wear a mask and that's the best defense. We say wear a condom and that's your best defense against STI. If you test positive, there's a protocol in place for COVID. You quarantine, you get tested, and um until you test pop negative, blah blah blah with herpes, right? If you have an outbreak, go in, get seen, get treatment, let your most recent partners know that maybe they were exposed. And then from there, like it's a matter of just waiting until the outbreak goes away, the symptoms go away. Same thing with co, you know, the whole 6 foot distance is the equivalent of limiting your number of sexual partners and like I said there's a lot here that can be done now. It's just a matter of will it be done?

Transitioning SPFPP and Closing Thoughts

00:28:30 Courtney Brame: I hopefully did no good enough job to uh have this renewed or be presented with other opportunities because there is so much work to be done in this space and I for a really long time have let my lack of credentials hold me back from pursuing what can be potentially lifesaving work. And that's what I'm beginning to believe and see the more that I'm supported by the organizations and the people around me who are helping me with making the dreams and the asks that I have into a reality because this this is tough, you know, it's tough to get people to be on board with why this is so important to me or how important this is and even at all. And so, yeah, I'm thrilled. I'm excited. And I want to thank each and every one of the podcast guests and um for our guests who didn't want to do the audio, excuse me, the audio publicly. Um thank you for taking the time to fill in the survey to be a part of this.

00:29:34 Courtney Brame: And uh like I said, this is a part of history, y'all. So everybody who's on here, these podcast episodes will begin to release on a weekly basis starting on September 21st, I believe. 21st, 22nd at midnight, one of those two days. And the Oregon Health Authority has everything. So, Something Positive has been at this point probably, you know, the last check should be coming out, but we'll have been paid for running this podcast and doing the exact same stuff that I've been doing over the last five and a half years for free, only collecting some data and information. So, I thank you for joining me on this journey. Thank you for being here. And um yeah, this concludes the Oregon Health Authority or actually this kicks off the Oregon Health Authority and Something Positive for Positive People um Oregon Health Authority podcast series. So, we got this and then 11 other podcast episodes coming up. I hope that you check those out on a weekly basis as they release.

00:30:33 Courtney Brame: And if there's something that you want to hear uh from Something Positive or if there's something that you're looking for and you need that, please don't hesitate to reach out to me. Now, I will say um I'm making a transition into focusing on Something Positive for Positive People as a business. And what that means now is if there are things that you need that you can access for free through the website, through the podcast or the social media accounts, and if it just requires you to do a little bit of looking or reading or listening, please do that. If you are not prepared to um invest in Something Positive for Positive People with a donation or content shares or being a guest on the podcast or if you need more than just a conversation… or if you want a conversation or need a conversation um I ask that you really consider the time that I put into this. Um I'm going to be offering well at this point. I am offering mentorship services and um therapy counseling services are also on the table. Uh but there is going to be an expectation that there is some level of investment because there's 5 and 1/2 years worth of free content out there through Something Positive for Positive People. So, um, I just ask that you contribute to the nonprofit because this is something that is supporting and helping the people who come through here and who may wish that they could give, wish that they could donate, but just can't. So, if you have the means of doing so, please do. And any service that you try and sign up for or utilize with Something Positive, you know, whatever you pay is tax deductible. Um, I'll get you the form for that to submit to or to submit along with your taxes if you need that. All right. Uh, till next time, stay sex positive.

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